Asthma Medications (cont.)

Syed Shahzad Mustafa, MD

After growing up in the Rochester area, Dr. Mustafa pursued his undergraduate studies at the Johns Hopkins University in Baltimore and attended medical school at SUNY Buffalo. He then completed his internal medicine training at the University of Colorado and stayed in Denver to complete his fellowship training in allergy and clinical immunology at the University of Colorado, National Jewish Health, and Children's Hospital of Denver.

Allison Ramsey, MD

Dr. Allison Ramsey earned her undergraduate degree at Colgate University and her medical degree at the University of Rochester School of Medicine and Dentistry. She completed her internal medicine training at the University of Rochester School of Medicine and Dentistry and remained at the university to complete her fellowship training in allergy and clinical immunology. Dr. Ramsey is board certified in internal medicine and allergy and immunology. Her professional interests include the treatment of drug allergy and eosinophilic disorders. She also enjoys teaching medical trainees. She is a member of the American Academy of Allergy, Asthma, and Immunology, the American College of Allergy, Asthma, and Immunology, the New York State Allergy Society, and the Finger Lakes Allergy Society. In her personal life, her interests include exercise, especially running and horseback riding; and spending time with her husband and two children.

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What are asthma medication guidelines?

The asthma medication guidelines classify asthma into different categories based on asthma symptoms during the day, asthma symptoms during the nighttime, use of rescue medications, impact of asthma on daily life, use of oral steroids, and breathing tests done in medical offices (spirometry). The asthma classifications include mild intermittent asthma, mild persistent asthma, moderate persistent asthma, and severe persistent asthma.

Patients classified as having mild intermittent asthma generally only require short-acting rescue medications. Mild persistent asthma is treated with inhaled corticosteroids as recommended first-line therapy, with a leukotriene modifier, theophylline, or cromolyn as alternative therapies to the inhaled corticosteroids.

Patients with moderate persistent asthma are usually treated with an inhaled corticosteroid/long-acting beta-agonist, a higher dose of inhaled corticosteroid, or an inhaled steroid plus a leukotriene modifier or possibly theophylline.

Patients with severe persistent asthma are treated with the higher doses of inhaled corticosteroids plus the long-acting beta-agonists, leukotriene modifiers, possibly theophylline, possibly tiotropium, and possibly anti-IgE therapy. Patients with difficult-to-control asthma often end up on multiple types of medications, and some may require oral steroids to maintain control.

What are over-the-counter (OTC) asthma medications?

All asthma medications require a prescription since patients with asthma should be followed regularly by a health-care professional. There are currently no OTC asthma medications that are recommended for use in asthma treatment guidelines.

What are the potential risks and side effects of
drugs used to treat asthma?

Common side effects of short-acting asthma medications (albuterol, levalbuterol) are a feeling of jitteriness, tremors, and/or heart palpitations. Hyperactivity can also occur, particularly in children.

The two most common side effects of inhaled corticosteroids are hoarseness or thrush, which is an overgrowth of yeast in the mouth. It is therefore recommended that patients using inhaled corticosteroids rinse their mouth after use. These side effects can also be minimized with proper inhaler technique. There is often concern about potential long-term side effects for inhaled corticosteroids. Numerous studies have repeatedly shown that even long-term use of inhaled corticosteroids has very few, if any, sustained clinically significant side effects, including changes in bone health, decreased growth, or weight gain. However, the goal always remains to treat all individuals with the least amount of medication that is effective. Patients with asthma should be routinely reassessed for any appropriate changes to their medical regimen. Although uncommon, the combination asthma medications may also cause palpitations or a sense of jitteriness due to the long-acting beta-agonists.

Omalizumab is generally a well-tolerated medication. Patients may experience some local irritation at the injection site. There is also a warning about the possibility of severe allergic reaction (anaphylaxis) occurring with use of omalizumab. It is recommended that patients on this medication have injectable epinephrine to use in the rare case this occurs. Omalizumab should also always be administered in a health-care facility.

Tiotropium may cause dry mouth or irritation of the throat. Theophylline may cause a sense of restlessness. It also can interact with other non-asthma medications so its use requires regular monitoring of blood levels.